MEDIASTINAL MASS AND TRACHEAL OBSTRUCTION DURING INDUCTION OF GENERAL ANESTHESIA

麻醉誘導時縱隔瘤與氣管阻塞

劉漢平(Hon -Ping Lau)；林珍榮(Luciana Susetio)

Acta Anaesthesiologica Sinica

28卷3期（1990 / 09 / 01）

367 - 370

英文

Cardiac arrest and death on induction of anesthesia is a rare and frightening event. Acute respiratory distress can occur anytime on induction of anesthesia, particularly in children with mediastinal masses, anesthesiologists should recognize patients at risk and alert such catastrophic respiratory complication may happen anytime during anesthesia. The following case illustrates the fatal consequences of failing to recognize the problem and anesthetic approaches to such problems are discussed.

心跳停止或氣道阻塞是最危急而且最嚇人的突發事件，我們報告一例病在麻醉誘導時縱隔瘤誘發急性氣道阻塞，雖經緊急處理，患者仍因缺氧死亡，藉此告訴大家麻醉縱隔瘤病人前需對病患有詳盡認知及麻醉的高險性，麻醉時需隨時準備突發性事件驟生，並作適當的處理，為避免類似不幸事件重演，我們建議（1）儘量使用局部麻醉（2）清醒氣管插管，（3）插管時儘量放置接近氣管隆突，（4）避免使用肌肉鬆弛劑，（5）氣管內視鏡隨侍在側隨時評估氣管內管是否因麻醉用藥，麻醉深度或體姿而受壓迫，並適時調整氣管內管位置，（6）如仍無法紓解氣道阻塞困境，可嘗試變換體姿如坐姿，側姿或伏姿。